To make this my mission at work? NHS/ retail related, please help!

[Areyoubeingservedhen]

Hello all,
I work in a secure hospital for mental illness. Most of the patients are men. We have a terrible terribly high rate of obesity/ morbid obesity due to the meds and these guys not having access to much exercise equipment. They're also lacking in motivation and nutritional information a lot of the time.
My main bugbear is that we have a vending machine in the hospital and that is pretty much it. We have a cafe which opens twice a week at lunchtime and sells sandwiches and homemade quiches but it's just reliant on one guy so if he's not in then it doesn't open.
Because of this the service users buy a lot of stuff from the vending machine, we estimated about £70-£100 per month! It's very overpriced and they have a captive audience who have no access to anything else apart from hospital food, toast and fruit. It's also a bit social. They get to go to the vending machine and see other staff/ service users. They get off the ward for a bit. Plus they get a mars bar.
My idea is for us to open the cafe when it's not in use and run it as a tuck shop 9-5 every day. It will sell healthy snacks and drinks at cost price (as we wouldn't want to make a profit) and also provide a social space. We would in the long run get service users to work there with staff and gain some skills which could be used for employment. Also maybe in the future we could make healthy snacks to sell (energy bars, protein balls, flapjacks.)
Can anyone see anything wrong with my business model? For example I wonder how much we would have to buy from a wholesaler, who would collect it, would they deliver? Also who would run the shop, would it be an HCA or would we hire a retail person. Presumably they would have to be trained in how to deal with any confrontation or abuse? Would we be allowed to sell multipacks or would we have to buy individual packs of things to sell even if we are not for profit? Would they still buy from the vending machines (we can't get rid as tied into a contract.)
Any help would be much appreciated before I speak to the head of operations! I'm a lowly administrator so I need to seem like I know what I'm talking about although I have ten years retail experience so know more about that side of things than the clinicians.

You will need to understand if there are premises and the contractural basis for operating a retail outlet - I expect the trust has a service level agreement and this would determine how you could operate. You would need a business case - £100 week turnover is not sufficient so you'll need to have a stronger case for opening. You'll need retail staff and to train them on issues around working in that particular environment - which might require vetting - you'll need to talk to HR. You might be able to talk to whoever operates the vending company and the engage them on trust policy for healthy eating and change the contents.

There's a lot to think about - but your enthusiasm is a good start point. Talk to the Ops/Estates Director and see if they're open to it. Good luck!

you might also need a food hygiene certificate.
could you consider tokens/tickets so that you don't have to handle cash?

Maybe chat to WRVS, they often run or did cafe and coffee shops in hospitals, many hospitals have volunteer coffee shops and although that’s not what you need the expertise maybe be similar and you might get some tips. The Christie in Manchester has this type of cafe, I wonder if there is a charity that could help you.
Good luck OP x

@khaleesi71 thank you for replying! I think we'd make a lot more than £100 per week. I would like to run it with help from service users, not sure if retail workers would be interested in working alongside people with serious mental health concerns, or if they would feel comfortable. The model I was thinking about was like a church tea room tuck shop or a school. Would that not be a viable model?

I think having worked in that sort of environment, if the vending machine was taken away/restricted I’d be booking some annual leave pronto, because I wouldn’t want to be about for that riot.

Can’t help with any practicalities I’m afraid, but just offering support and cheerleading! It sounds like a brilliant plan, giving some structure and possibly transferable skills to your patients. Do you have an occupational therapist on site? it’s the kind of thing ours would love to be involved in!

I think it would work yes if you had service users volunteering, I still think you might get a charity interested, or does the hospital have a league of friends or the hospital Chaplin who would support you.

@CalmFizz they're not going to be, our plan is to give an alternative and then if business for the vending machine dwindles then we can look at if we need it. Removing the vending machines is not an option as the night staff need to have somewhere to get a snack.

@moocowmrs thanks for the tip!

So, you're not running it for a profit, selling things at cost price. How are you going to afford to hire someone to run it? Are you a private facility that has sufficient money laying about to fund extra staff members? Would they have to work alone? Is it safe for them to do so? Would you have to budget to pay for 2 members of staff to cover all of those hours?

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@yellowellies we have lots but they've got very big caseloads, taking service users to the gym and teaching them to cook. This is just me, an ex shop keeper, trying to find a practical solution to a problem.

OP, there are other secure hospitals doing this, so there are models that can be followed. I work in one, but am not involved in the cafe/tuck shop, which are run jointly by matron/OT departments. Because I work in a different clinical area I can't advise on the specifics, but I can tell you that precedent is there, and perhaps most importantly it is a success with the patients.

@britnay I mean we have lots of staff. It would involve rota-ing staff into the shop, making sure we have a core team of people who know how to run the shop.

I second getting in contact with the wrvs - they are usually staffed by volunteers with some paid. They definitely don’t charge cost price though!

I should add that ours is not open all day, every day. It operates for breakfast and lunch 9.30-1.30, and two afternoons weekly. Might be easier to get started just running half a day on the days the cafe is closed?

if service users are volunteering then you will need at least one clinician in with them, not just volunteers/retail people, for all the usual secure unit reasons.

@SecureUnit thanks, I knew there would be. When I was mentioning this today everyone acted like it couldn't be done. I think they see it as a lot of work. If I took it on then I would have to make sure that the plan is very very solid and that there's an idea of how it's going to run long term. I'll speak to our matron (they're so busy though!)

@SecureUnit definitely. We would need them to be trained and so can't be retail assistants. However they would need to have their food hygiene, know about stock rotation and also just have a bit of personality because that's what will keep people coming back!

I would second talking to the WRVS. I also think you need to rethink the profit aspect. You will need a reserve - stock might get damaged (melt in a heatwave for instance), not sell and go out of date or go missing. However it could be run as a social enterprise so all profits reinvested and should it be wildly successful be donated to add on items for the ward. PPs are right you will need to work out the existing terms the shop is run under and who owns the equipment in it (SLA), think about insurance and any regulatory requirements (eg food safety).

It sounds a great plan. I think it would be easier to train a HCA to do the retail side than a retail person to work in this role. As you said your patients go to the vending machine for social reasons as well as for food. I think it would be beneficial to agave someone working who is confident conversing with people who are mentally ill. It might provide a bit of casual talking therapy. Pps mentioning getting a charity on board, what about a charity like MIND?

It sounds a great idea.

Mental health hospitals are some of the least healthy places I've ever seen. No fresh air, no ability to exercise, no activities, no mental stimulation, shit food. Discharged physically ill, unfit, overweight, addicted and traumatised. I had friends go into hospital non-smokers and come out addicted because the only activity and place to socialise was the smoking room. Never mind the PTSD they acquired In hospital. Really fucking helpful.

Good on you for trying to find a way to do something about that national disgrace. Genuinely, what a refreshing thing to read.

How much scope would there be to involve service users in developing these plans and running it / making decisions?

I think it would be really important - as far as possible - that it be something run/developed by them not yet another thing done to them or imposed on them that they have no influence in or say over. Co-production and all that.

Your perception (and staff perceptions) of what is important, how they would benefit etc will be different from those of service users. There is such a huge power differential between staff and service users, so I would be very mindful of not taking more power away from people.

I can't think of any practical advice right now, but on a more personal level please don't get disheartened if people are jaded or unenthusiastic. I hope you won't give up on the idea of making a positive difference. Even if the idea you have now develops into something a bit different or doesn't reach as many people as you're hoping.

Locally I've seen some really brave and innovative projects finally start to get off the ground, so it can happen when people like you come along and are prepared to plug away until they get the model right and make the right connections to make things happen. It's so worth it.

Good luck.

Networking might be key here.

Some of your clinicians will probably be involved in the Quality Network for forensic MH services, where clinicians visit different units to peer review and share good practice. Perhaps you could ask someone to have a look at how other units run theirs next time they're on a QN visit?

@quincejamplease we are getting there. Trying! We have a gym, we have a gym on the rehab wards (not acute wards unfortunately.) The food drives me scatty. Imagine eating essentially a ready meal for tea every night for years!
Trouble is logistics. Whose going to cook that food? Whose going to pay for it. We have £5.20 per service user per day to feed them breakfast lunch and dinner. We have started to cook from scratch at dinnertime two or three times a week, but we don't get that £5.20 back. So we have to pay out of our budget essentially for two meals.